PubMed · 12701311
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Finn Korsgaard. 2003-03-17. [Direct current conversion].. https://pubmed.ncbi.nlm.nih.gov/12701311/
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OBJECTIVE: Transthoracic impedance (TTI) is a factor determining the magnitude of the transmyocardial current during external defibrillation. Minimising TTI increases the chances of successful defibrillation. Most external defibrillation paddles are rectangular in shape and can, therefore, be placed in a transverse or longitudinal orientation. The apical paddle is often placed in a transverse orientation. This may theoretically result in a higher TTI than a longitudinal orientation because of poorer contact at the lateral paddle edges. We compared TTI with the apical paddle in both a transverse and longitudinal orientation. MATERIALS AND METHODS: Twenty sequential anaesthetised patients were studied. A pair of defibrillator paddles were instrumented to measure paddle force. TTI was recorded pre-operatively at end-expiration with the apical paddle in both longitudinal and transverse orientations. The sternal paddle was placed in a longitudinal orientation for all measurements. RESULTS: TTI decreased in both transverse and longitudinal orientations as paddle force increased. Transverse paddle orientation resulted in a significantly (P<0.01) higher TTI than longitudinal orientation at all paddle forces below 12 kg force. CONCLUSION: The longitudinal orientation of a rectangular defibrillation paddle provides a lower TTI than orientation horizontally.
Heart failure is a clinical syndrome not limited to age or ethnicity. Patients with heart failure, compensated and uncompensated, may present for emergency or planned surgery. Patient outcomes depend on the knowledge and nursing care of the perianesthesia nurse. An understanding of the types of heart failure, etiology, pathophysiology, hemodynamic factors, and treatment will assist the nurse in making decisions that will affect the clinical course. Evidence-based practice will facilitate the perianesthesia nurse in reducing morbidity and mortality in this patient population.